The worldwide AIDS epidemic has often been perceived as primarily affecting men, yet internationally, women make up roughly half of all people living with HIV/AIDS. Here in the United States, women are one of the fastest growing population living with HIV, currently making up an estimated 30% of new HIV infections. Only fifteen years ago, women accounted for less than 7% of Americans living with HIV/AIDS, so their representation in the HIV-positive population has more than tripled in a relatively short time span. This is a significant increase, one that has been called a "profound shift" by U.S Surgeon General David Satcher. It calls for renewed attention to the ways in which women become HIV positive, and a renewal of efforts to create woman-friendly barriers to HIV transmission.
Around the world, including in the U.S., most women become HIV-infected through sexual contact with men, generally by a boyfriend or husband. Cultural norms around the world make it difficult for women to insist that their sex partners consistently and properly use condoms. All too often, and with elevated frequency in patriarchal cultures and communities, women risk suspicion, isolation, and even violence for merely suggesting condom use. Within our own country, a 1998 U.S. Department of Justice study found that one out of four American women will be battered or sexually assaulted at least once in her life by a boyfriend or husband. This study shows that even in our relatively progressive culture there is a high prevalence of relationships in which women do not have optimal control over their intimate relations, and are thus at increased risk for being unable to ensure condom use.
Because of these factors, which constitute significant barriers to women's use of condoms, condoms cannot be the only tool the world offers to prevent HIV transmission through sex. Until there is a safe, effective, and accessible vaccines and until the status of women improves around the world, women need tools they can control and use that protect against transmission of HIV and other sexually transmitted infections.
In response to the combined realities of gender inequality and increasing HIV-infection in women, a global effort is underway to promote the development of "Microbicides" -- anti-HIV agents that could be used and controlled by women. Currently in development, microbicides will be a new class of HIV prevention tools, chemical substances that -- when applied to the vagina or rectum -- will reduce the transmission of sexually transmitted infections (STIs), like HIV. Scientists are now trying to develop microbicides in non-prescription gels, creams, foams, and lubricants -- forms that would be made available at any drugstore.
Microbicides are not being developed in order to take the place of condoms, which when used properly provide excellent protection against HIV transmission. Rather, microbicides would be an HIV-prevention tool that would place significantly more control into the hands of women, who could, in theory, use them without the knowledge of the man they were having sex with. In addition, microbicides would provide men with another tool that they could use for preventing HIV transmission. [See "Microbicides and Men."]
There continues to be an urgent need for the public and policymakers to become more educated about the need for safe and effective alternatives to condoms, and to become educated about the potential benefits of microbicides. It is clear that with the proper investment and federal funding, microbicides could be developed within two to five years. Having safe, effective, accessible, and affordable microbicides would drastically reduce infection rates throughout the world, particularly among women and children. With 6,300 women around the world newly infected with HIV every day, investing in microbicide research and development is an effort we should not postpone. [See "Easy Ways to Support Microbicide Research and Development."]
|Microbicides and Men|
While much of the impetus for developing microbicides comes from the need for HIV-prevention tools that can be controlled and used by women, microbicides have enormous potential to benefit men, as well.
As currently conceived, microbicides will provide bi-directional protection, meaning: microbicides will protect any party to sexual intercourse, fighting pathogens in vaginal secretions and semen. In this way, a vaginally applied microbicide would protect both a man and a woman engaged in sex, regardless of the HIV status of either.
But a vaginal microbicide is not all that is needed. Anal sex -- engaged in by both same-sex and different-sex couples -- is a primary mode of HIV transmission through sex, and because the rectum and the vagina are very different biological environments, microbicides must be formulated that are specific to each.
Unfortunately, and largely due to the social stigmatization of anal sex -- straight or gay -- less effort has been put into discussions about and support for rectal microbicides. But especially for men, who are at greatest risk of becoming HIV infected through sex with other men, rectal microbicides could provide a critical new tool for the prevention of HIV transmission. Because of this, all support for microbicide development and research should emphasize the importance of rectal microbicides.
|Easy Ways to Support Microbicide Research and Development|
Kaethe Morris Hoffer is manager of federal affairs at the AIDS Foundation of Chicago (AFC). Grisel Robles is AFC's Outreach Assistant -- a position created through a partnership between AFC and the Global Campaign for Microbicide Development. Kaethe and Grisel work together to support greater federal funding for microbicide research and development, and they can be reached via AFC's Web site at www.aidschicago.org.